SKH Revisions
25-1, Revises Sections Throughout the Handbook
Revision Notice 25-1; Effective March 1, 2025
Section | Title | Change |
---|---|---|
1320 | Service Coordination and Programs Serving Member with Intellectual or Developmental Disabilities | Amends language for clarification purposes. Removes example of PDN. |
2030 | Managed Care Organization Coordination | Amends language for clarification purposes. |
2112 | STAR Kids Member Residing in an NF | Amends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP. |
2210 | Medical Necessity Expiration | Updates instructions for MCOs to submit member SK-SAI’s to the TMHP Long Term Care Online Portal. |
3110 | Assessment of Medical Necessity for Community First | Updates to change Medicaid Management Information System to Long Term Care Online Portal. |
3120 | Assessment of Medical Necessity for the Medically Dependent Children Program | Updates to change Medicaid Management Information System to Long Term Care Online Portal. |
3210 | Reassessment of Medical Necessity or Level of Care | Amends language for clarification purposes. |
3320 | Service Planning for Medically Dependent Children Services | Amends language for clarification purposes. Removes language that MCOs receive a response file from TMHP. |
3322 | Medically Dependent Children Program Individual Service Plan and Budget Revision | Amends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP. |
3329 | Reassessment Notification Requirements | Updates the number of days required for PSU staff requirements if a member files a state fair hearing or external medical review. |
4111 | Determining Institutional Level of Care | Amends language for clarification purposes. Removes reference that TMHP makes MN determinations on behalf of HHSC. |
4131 | Assessment of Nursing Facility of Care | Amends language for clarification purposes. Removes reference that TMHP evaluates member eligibility for NF services. Replaces references to TMHP with HHSC. |
4132 | Reassessment for a Nursing Facility Level of Care | Amends language for clarification purposes. Updates language to include Medicaid Management Information System. |
4300 | Private Duty Nursing | Corrects links to TMPPM’s Home Health Nursing and Private Duty Nursing Handbook, and TMPPM’s Children’s Services Handbook. |
6200 | Denial/Termination of Medically Dependent Children Program | Amends language for clarification purposes in Provides additional language for clarification of when HHSC terminates MDCP enrollment. |
6210 | Denial/Termination Due to Death | Amends language for clarification purposes. Updates language to clarify when HHSC will terminate MDCP enrollment. |
6220 | Denial/Termination Due to Residence in a Nursing Facility | Amends language for clarification purposes. |
6240 | Denial/Termination as a Result of Exceeding the Cost Limit | Changes title to Denial or Termination as a Result of Exceeding the Cost Limit Amends language for clarification purposes. Updates language to include Medicaid Management Information System. |
6250 | Denial/Termination of Medical Necessity | Changes title to Denial or Termination of Medical Necessity Amends language for clarification purposes. Replaces references to TMHP with HHSC. |
7300 | State Fair Hearing Requests- Appealing MCO Actions | Removes a reference to applicants and members requesting a state fair hearing for non-eligibility reasons. |
7310 | Program Support Unit Coordination | Amends language for clarification purposes. Replaces references to TMHP with HHSC. Updates timeline where staff must enter SFH requests for MDCP eligibility in TIERS. |
7312 | Evidence Packet | Amends language for clarification purposes. Replaces reference to TMHP with HHSC Office of Medical Director. |
7321 | Presentation of the Evidence Packet | Updates references to TMHP and HHSC, along with the MCO. |
7322 | Hearing Decision | Updates references to TMHP and HHSC, along with the MCO. |
7410 | Action Taken on the Hearing Decision | Deletes section and changed title to Reserved for Future Use. |
7610 | Sustained State Fair Hearing Decisions | Update language. Clarifies that HHSC Fair and Fraud Hearings staff mails out written decisions to the applicant, member or their legally authorized representative. |
7612 | Reversed Appeal Decisions | Amends language for clarification purposes. Updates TxMedCentral reference to MCOHub. |
7700 | Roles and Responsibilities of Texas Health and Human Services Commission Hearing Officers | Deletes section 7700 and replaced with Section 7800, Community First Choice State Fair Hearing. Amends language for clarification purposes. |
7800 | Community First Choice State Fair Hearing | Moves to Section 7700 and deletes Section 7800. |
Appendix I | MCO Business Rules for SK-SAI and SK-ISP | Updates Section 2.5. Advises MCOs to contact HHSC with more needed information for MDCP MN determinations. |
Appendix XI | STAR Kids Plan Codes | Updates Amerigroup to Wellpoint and Children’s Medical Center to Aetna for the Dallas Service Area. |